Organization
PATINA MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRA MARIE RISTOW MD (LEAD PRIMARY CARE PHYSICIAN)
(573) 999-7137
Entity
Organization
Contact information
Practice address
150 MONUMENT RD, BALA CYNWYD, PA 19004-1702
(949) 246-3344
Mailing address
150 MONUMENT RD, BALA CYNWYD, PA 19004-1702
(855) 478-8208
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
08/02/2022
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